Authors: Michael Palmer
“Whatever Caspar wants, Caspar gets,” Harry sang to the “Lola” tune.
“I don’t have very good vibes about this at all, Harry.”
“I can’t think of any reason you should.”
Caspar Sidonis, in his early forties, had a matinee idol’s good looks, which he augmented by being impeccably and expensively dressed at all times. He had been first in his class at Harvard Med and never, ever let anyone forget it. He had also won MMC’s tennis and squash championships
several years running, and was rumored to have been a collegiate boxing champion.
“Green Dolphin Street” intensified in Harry’s head. Funk or no funk, he did not want to be told what he could and could not do as a physician—not by HMOs, not by insurance companies, and especially not by a pompous, overblown, crank-’em-through supertechnician like Sidonis. He glanced around the hall at the other GPs, thinking about all those years of study, the countless hours of continuing-ed courses, their willingness to endure the low prestige and even lower reimbursement that went with being a family practitioner. They deserved to be rewarded, not restricted.
“Harry, for chrissakes, say something. They’re crucifying you.”
Doug Atwater, seated to Harry’s right, clenched his fist in frustration as, one by one, the Sidonis committee’s recommendations were presented to the medical staff. To Harry’s left, Steve Josephson was shaking his head in disbelief. He had tried arguing against the first of the committee’s proposals, which required that a board-certified obstetrician be present for all deliveries. Josephson had once made headlines when, as a passenger stuck in a disabled subway car, he had successfully delivered the twins of one of the other passengers. Now, it seemed possible that deliveries in such situations would be the only ones he would be allowed to perform.
The vote, despite Josephson’s emotional arguments and well-publicized heroics, was nearly unanimous. Only the three GPs who still did deliveries voted
nay
. The rest abstained, perhaps believing that the staff would conclude they were responsible enough to police themselves, and back off from supporting the other restrictive resolutions.
“There goes the new refrigerator,” Harry said.
The next resolution, requiring GPs to turn over their Coronary Care Unit patients to a cardiologist or internist, passed easily. The cardiologist who had taken over Clayton
Miller’s care was one of the few dissenters who wasn’t a GP. Then came the vote to limit surgical participation by GPs to first assisting only. Again Sidonis’s committee prevailed.
“History will refer to this next one as the Marv Lorello Proviso,” Harry whispered as discussion began on the last of the committee’s proposals.
“It is recommended,” Sidonis began, adjusting the Ben Franklin reading glasses that Harry sensed he wore more for his image than for his vision, “that all suturing done in the Manhattan Medical Center emergency ward by a non-surgical specialist be approved in advance by the senior emergency physician on duty.”
The murmur around the amphitheater suggested that many were surprised by this final, and perhaps most humiliating proposal. Harry had had advance warning, but the words stung nevertheless.
“There have been,” Sidonis went on, “a number of cases reported to our complaint committee, and to our liability carrier, in which improper technique was used or faulty judgment displayed by certain non-specialists. Mrs. Brenner of our risk-management office has assured me that developing some sort of internal pretreatment screening policy could significantly reduce the number of claims against our non-specialty staff members.”
He glanced vaguely in Marv Lorello’s direction, and several dozen pairs of eyes followed. Lorello had joined the staff just a few years before after serving three years on a reservation in the Indian Health Service. He had impressive academic credentials and a refreshing idealism about practicing medicine. The malpractice suit—his first—and the subsequent fallout from it had hurt him deeply. Harry
did
his best to remain externally placid. But “Green Dolphin Street” was playing on, up-tempo now and louder.
Then suddenly, the music stopped. It took several seconds before Harry realized he was on his feet, his six-one frame the center of attention of everyone in the amphitheater. He cleared his throat. The faces stared up at him, waiting.
“If it’s all right with the chairman,” he heard himself
saying, “I … um … I guess there are a few things I need to get off my chest before we vote on this last—and for the family practitioners, most degrading—proposal of this commission.” He paused for objections and half felt Sidonis was about to voice one. The silence, however, was total. “Okay. Thanks. It’s not my intention to belittle anyone’s specialty by implying that someone with less training might be able to do exactly what it is they do. But I do want to stress that we generalists are well trained to do
some
of those things. We are board-certified in family medicine, not half-assed medicine. We went to medical school just as you did, we had residencies just as you did, we care about our patients and continue our education just as you do; and most important, we recognize our limitations, just as I hope you do.
“Most of us can handle being treated with the sort of disdain I’ve heard expressed here today.” He looked pointedly across the auditorium toward. Sidonis. The impressive silence continued. Not a cough. Not a clearing of a throat. Not a creaking of a seat. “We can handle it because we believe in the specialty of medicine we have chosen. Now, we’ve become something of a convenience to the insurance companies and HMOs. They call us primary care physicians. By that they mean medical traffic cops, screening the mundane and insignificant complaints so that the much more expensive specialists won’t have to deal with them. And that’s okay. Most of us have adjusted to that new order, too. Just as we’ll adjust to first assisting on simple appendectomies and other operations we have performed dozens of times ourselves, or turning our coronary care patients over to someone they don’t know.
“But this—” Harry gestured to the huge screen behind Sidonis, on which was displayed the last of the committee’s recommendations! “This I simply cannot accept. You know, we doctors persistently lay the blame for the malpractice crisis on lawyers. There are too many lawyers. The contingency system is wrong. The way they advertise is inflammatory. Well, that may be so. But that is hardly the whole story. Patients don’t know us anymore. We don’t portray
ourselves as partners in the business of keeping them healthy. Instead, most of us come across as just what we are—specialists, interested only in making sure that the body part we have become expert at works properly. Hey, lady, I’m sorry you have to get to Brooklyn, I never drive past Forty-second Street. Well, I know how to suture. I’ve sutured wounds you wouldn’t believe in situations you wouldn’t believe. I’m damn good at it. So is Dr. Josephson, here, and Marv Lorello, and every one of the rest of us who chooses to sew up our patients when they cut themselves. I don’t need to be told what I can and cannot fix. None of us does.
“So I say,
enough
. The return to the kinder, gentler days of the rumpled, overworked family practitioner makes for great conversation around the medical cocktail party circuit. But when the chips are down, no one’s ready to challenge the great god science, and to say that there’s still a place for doctors who know their patients as whole people, and want to care for them regardless of what is wrong. I wish that instead of limiting this session to medical staff members you had invited some of those patients to be here. Once you understand what
having
a doctor means to them, perhaps you will remember what
being
a doctor should mean to us. These proposals are all humiliating and unnecessary. But this one is even worse than that. Don’t pass it.”
Harry hesitated and then sank to his seat. The heavy silence continued. Finally, Steve Josephson reached over and took his hand.
“Thank you,” he said hoarsely. “Thanks for trying.”
Then, from across the amphitheater, the applause began. It spread quickly around the hall until nearly everyone had joined in. Then they were standing. Several of them cheered out loud. Others rapped on the wooden seatbacks in front of them. Caspar Sidonis sat rigidly in his seat, crimson beneath his perpetual tan. The other members of the committee shifted uncomfortably.
“It appears there is a great deal of sentiment surrounding this proposal,” Sidonis said after he had finally managed to reestablish his authority. “I would suggest that
perhaps we should table further discussion until our committee can meet again with the risk-management people and reconsider this issue.”
“No, let’s vote!” someone shouted out.
“How about another vote on all those proposals,” another yelled.
Suddenly the entire medical staff seemed to be talking and arguing at the same time. Sidonis, bewildered and unsure of how to handle the situation, looked about for help. He was bailed out by the chief of the medical staff, a burly orthopedic surgeon who had twice been an All-American linebacker at Penn State.
“Okay, everyone, cool it!” he barked out. “That’s it. Thanks. I want to thank Dr. Sidonis and his committee for a job well done. It seems this last issue is controversial enough that we ought to sit on it for a while. I know this whole business of who does what is not easy, and would like to praise the staff for its courage and the nonspecialty practitioners for their understanding.” Two physicians booed. “Come on, grow up,” the chief snapped. “We gave Dr. Sidonis and his committee a mandate, and they have lived up to it. Now, I think we owe them a round of applause.”
Grudgingly, the staff complied. The session ended with a word of praise for the hard work of the Sidonis committee, and a plea for understanding and unity among the staff.
“You primary care physicians are still the foundation of our medical delivery system,” he said. “Never forget that.”
Harry accepted the handshakes and congratulations of Doug Atwater, Steve Josephson, and a number of the other staff members. But he knew that while he had helped the GPs save face, their loss of stature was severe. The ground-swell of support following his speech had not changed that. He worked his way free and headed down toward the exit by the amphitheater stage. He was nearly there when Caspar Sidonis stepped in front of him. For a moment, Harry thought the former boxer was going to take a swing at him.
“Enjoy your little show while you can, Corbett,” he
said. “It’s not going to make a bit of difference around here. You’ve always been a wiseass. But this time you’ve picked the wrong person to fuck with.”
He whirled and stalked away.
“Asking you over for tea?” Doug Atwater asked.
Harry recovered and forced a smile.
“There’s something going on with that guy and me. Something beneath the surface that I don’t even know about,” he said.
“Forget about him,” Doug replied. “Come on. Let me buy you a Coke. You’re a hell of a guy, Harry. A hell of a guy.”
It was midmorning when Harry finished dictating two discharge summaries and left the hospital for the six-block walk to his office on West 116th Street. The day was cloudless and just cool enough to be invigorating. Still, despite the weather, he sensed the return of the persistent flatness that had been dogging him for months. It was a feeling unlike anything he had ever experienced before—even during his year of pain and disability. And his failure to simply will it away was becoming increasingly frustrating. Distracted, Harry stepped onto Lexington Avenue against the light and narrowly missed walking into a Federal Express truck.
“Hola
, Doc, over here!”
The cabby, dropping off a fare, waved to him from across the street. It took a moment, but Harry recognized the husband of one of his obstetrics patients—one of his
last
obstetrics patients, he thought grimly.
“Hola
, Mr. Romero. How’s the baby?” he asked once he had made it across.
The man grinned and gave an A-okay sign.
“You need a ride anyplace?”
“No. No, I don’t, Mr. Romero. Thanks anyway.”
The man smiled and drove off.
The brief exchange gave Harry a boost. He started walking again, picking up his pace just a little.
The canary yellow Mercedes convertible was parked by the hydrant in front of the building where Harry had a ground-floor office. Phil Corbett was grinning at him from behind the wheel.
“Shit,” Harry whispered.
It wasn’t that he disliked his younger brother. Quite the contrary. It was just that Phil was harder for him to take on some days than on others. And today was one of those days.
“A mint condition vintage 220SL with sixteen thousand miles on her,” Phil said, motioning him in. “I just picked her up at my midtown showroom. Do you have any idea what this baby’s worth?”
Phil’s formal education had ended one month into community college, when he gave up trying to compete with Harry and joined the Navy. Three years later he was back in civilian clothes, selling cars. The profession was tailor-made for his ingenuous smile, uncluttered psyche, and perpetual optimism. Five years after his first sale, he bought out the owner of the agency. After that, he began to expand. Now, six agencies later, he had two daughters and a son in private school, a lovely wife who couldn’t spend what he made even if she wanted to, and a three handicap at one of the most exclusive country clubs in New Jersey. He also had no trouble dealing with life’s big questions. He never asked them.
“Eight hundred and seventy-three thousand, four hundred and ninety-two dollars and seventy-three cents,” Harry said. “Plus tax, destination, and dealer preparation charges. You been to see Mom?”
“Tomorrow. How do you know how much this cost?”
“I don’t. That’s my total lifetime gross income. I went down to the home last Tuesday. She didn’t know who I was.”
“I guess that’s the upside of having all those strokes.”
“Very funny.”
Phil studied his older brother.
“Harry, you okay? You look terrible.”